By Mylika Scatliffe
Special to the AFRO

The recently passed Black Maternal Health Momnibus Act of 2021 addresses maternal mortality in the Black community by ensuring women have access to equitable maternal healthcare. An important part of this bill includes funding for community-based resources and organizations that work to improve maternal health outcomes and promote equality. Doulas are community-based birth workers who advocate for the mental, emotional, physical and spiritual well-being of the expectant mothers during and after pregnancy, and are one of the most under -utilized resources. Unlike midwives, doulas are not medically trained in prenatal care and cannot deliver babies, but they are essential in securing the connections with maternal health resources and information. Factors such as exhaustion, medication, intimidation and confusion sometimes render pregnant, laboring and postpartum women unable to advocate for themselves.

The pregnant women of Baltimore City and areas in Maryland, Virginia and Pennsylvania are at a distinct advantage, because of the SAFE Sistas. The SAFE Sistas Doula Collective is a cohort of seven birth workers who came together in 2019 in Baltimore. These doulas have similar values and goals and are passionate about serving their community.  During their training they felt spiritually intertwined and that God put them together to fill a need. Being in the company of Keyawna Scruggs, Shontae Gainey and Sybil Cooper makes it clear that their passion for their purpose and desire to serve the community is palpable. They were trained under an organization called The Birth Well, which is specifically tailored to the needs of pregnant women in the Black community.

The SAFE Sistas Doula Collective

“I don’t really like to use the word ‘empower,” when talking about African Americans because we already have the power, but our wish is to cultivate a community of support, education, advocacy and access to equitable care,” Cooper said in describing the collective’s mission. The members of the Safe Sistas noticed a deficit in birth support, knowledge and a mother’s ability to advocate for herself which leads to trauma during the birthing process. They share their negative experiences and proceed to traumatize first time mothers.  

“Birth should be a wonderful and positive experience overall,” said Cooper. Racism and bias among medical professionals are disturbingly common. Countless studies show that medical professionals believe Black people can tolerate more pain, and Black women are perceived as being dramatic, angry, and aggressive when voicing their concerns and/or pain during their birthing experience. Systemic racism, indifference, blatant disrespect by a medical team is traumatizing during the birth experience, which is one of the reasons there is a need for trauma-based care.   Cooper is passionate as she says, “We are here to fill the need for sisterhood and community healing.”  

Sybil Cooper with a newborn baby after a birth she attended with the mother.

A doula’s intervention doesn’t have to be just for traumatic situations. Gainey explains, “We prepare mothers and teach them to use their voice because the only relevant voice in the birthing room is theirs.”  Advocacy isn’t just about speaking up when being treated badly. It’s also about asking questions and for additional information about a course of treatment. “There’s no questioning intervention when it’s medically necessary, but outside of a dire situation a laboring woman has every right to ask questions about her treatment, or to have a birth plan,” Gainey notes. “It’s also okay for her to ask questions about the medication being hung in an IV. To ask the doctors and nurses to step out of the room so she can discuss her options with her partner or her doula.  To question if medical intervention, such as epidurals or C-sections are truly necessary and in her best interest.  To state she doesn’t like someone’s attitude towards her and to start over.” 

Keyawna Scruggs assisting a laboring mother, along with the mother’s partner.

There are several kinds of doulas – birth doulas, fertility doulas, abortion doulas, and bereavement doulas. The ladies in the SAFE Sistas Collective are birth doulas.  Scruggs, the mother of five, Gainey, the mother of four, and Cooper, the mother of three, all strive to be the type of doulas they wish they had when they were having babies.  Cooper recalls being a first-time teen mother and wanting a doula, but not knowing where to find or how to afford one. One of the ways the collective helps the community is partnering with other community-based organizations and nonprofits to provide doula services at low or no cost. The cost of a doula ranges from $500 to upwards of $2500, with the average cost being around $800. The SAFE Sistas charge $400. Insurance typically doesn’t cover doula services. Some insurance plans may offer reimbursement, but that means a mother must come out of pocket for the expense first. With a high percentage of their clients being on Medicaid, and perhaps having to choose between paying for a doula and purchasing things the baby will need, a doula may not be an option.

Shontae Gainey

A birth doula’s work begins during the prenatal period. The services provided by the SAFE Sistas include two prenatal appointments, the birth and at least one hour immediately after the birth, and a postpartum appointment. Mothers often have never been educated about how to take charge of their birth plan, how to advocate for themselves, and resources available to them. This is where doulas fill a vital role. 

Keyawna Scruggs poses with this mother and newborn shortly after birth.

The recurring theme during our conversation was support.  Doulas provide support to mothers who may not have anyone else to accompany them to prenatal appointments or the birth.  Scruggs told me, “You’d be surprised how many people don’t have friends or family to be present for them.  Or how many mothers may have five or ten people attending the birth because they want to be the first to see the baby, but no one is there just for her.”  She described how a mother can have a room full of people basically being bystanders who are just eating, scrolling through their phones, watching TV, and chatting about how long the birth is taking, but having no direct involvement in supporting their family member in labor.  Doulas provide education and guidance to a mother’s family support system. Scruggs particularly wishes to see partners be intimate with a mother in labor. “I’ve been known to hide the father’s cell phone to redirect his attention and energy to the mother.  Just like he was involved in the bedroom to make the baby, he can be involved in the labor room.  I tell him, “Whisper in her ear, tell her she’s beautiful and amazing. Rub her back, walk with her, pray with her, hold her hand, talk to the baby.  We (doulas) can do all those things for her, but she will absolutely receive it better from her intimate partner, with whom she created this baby.”

Cooper believes in providing as much comfort in labor as possible through physical touch, educating those attending the birth on how to identify stress in the mother and how to read her cues and to relieve that stress.   She also believes in recognizing stress in the partner and providing ways for them to cope as well. “Labor is, of course painful for Mom; she’s doing all the physical work, but it’s hard for her partner to see her in so much pain and they may feel helpless. And sometimes, in those moments, Moms can be kind of mean and hurt Dad’s feelings,” laughs Cooper, “so we have to redirect and keep everyone focused on the task at hand.”

Gainey requires partners and anyone else who will be present at the birth to attend the second prenatal appointment.  She educates them on her role, and their role. She explains how anyone attending the birth should be prepared to play a role in supporting the mother and have a designated job in the labor room – holding the mother’s legs, feeding her ice chips, rubbing her back – whatever she needs.  She explains, “Some people are just focused on seeing the baby and don’t mean to not be supportive. It’s my job to remind them this is a sacred, spiritual experience, and that the mother deserves for everyone to focus on her needs in this moment. Doulas don’t replace loved ones; we just control the environment. I’m here to hold space and be a gatekeeper. And I’m honored to do it.”   

Ideally, doulas and medical professionals should work as a team.  All three ladies describe positive experiences with hospital medical staff, as well as some challenging situations.   “A lot of the nurses are glad to have us there. They may be in a situation where they’re short-staffed and can’t respond and check on a mother as often as they would like while they’re in the labor room. Having us there to give mothers some ways to cope with pain and anxiety frees them to take care of other patients that also need attention,” according to Scruggs.  It is the most positive experience for the mother, and all involved when doulas and hospital staff remember that they’re all part of the same team. Doulas absolutely respect the medical expertise of doctors and nurses and feel that it works best when the medical staff realizes doulas are not there to usurp their positions, but as support for the mothers and their families.  However, laboring mothers absolutely have the right to follow their birth plan, to be able to walk, squat, kneel or whatever they need to do relieve their pain and ease labor and not be confined to the bed or rushed into having labor induced because to fit a doctor’s agenda that may not even be related to the mother’s situation.

“Sometimes I can just see the change in their countenance when they see us coming,” said Gainey, describing how some doctors and nurses are not happy to see a doula coming in with a laboring mother.  “They may recall an experience with a doula that may not have been positive because of the doula’s actions, which now colors their perception of all doulas.” She went on to say this often leads to her having to be overly accommodating and gracious just to let the staff know they’re all on the same side.  In turn, the nurses will recognize what they are doing to help the mother and may ask for a demonstration of some of their pain relief and relaxation techniques.”

Everyone in the SAFE Sistas Collective in some way or another always had a connection with mothers and babies. Each doula that was present for this conversation felt called to be doulas for different reasons. “We were all doulas before we were actually doulas,” said Cooper.     “I do well with first time mothers, and I often act as a mentor to younger mothers.”

Gainey deals with a lot of mothers who’ve suffered traumas- abandonment by parents, molestation, abusive relationships. “We learn what they have been through and what triggers them, so we’ll know what not to do or how to touch or not touch them during labor.”

Scruggs summed up the view of all the ladies in the collective, even the ones not present for this interview. She said, “It’s not a choice, it’s a calling. God doesn’t call the qualified. He qualifies the called. This is a ministry.”

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